Grommet Consent Form

Grommet Gurus Consent Form
Name of Participant

First NameLast Name
Name of Parent/Guardian

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have family members involved in the program?
Who are the family members involved
This will help identifying right patrol group.
What are your interests?
What do you want to get out of lifesaving and this program?
1234N/A
YesNo
YesNo
I Parent/Guardian the parent/guardian of Participant's Name give consent for my child to partake in the Grommet Gurus Program.
Signature of Parent/Guardian
Date

MonthDayYear
Date
Should be Empty:

Grommet Gurus Consent Form